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Widespread Funder Support For Mental Health Care - healthaffairs.org

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Widespread Funder Support For Mental Health Care

Mental health is a concern for many sectors of American society. The Health Resources and Services Administration announced in a July 2021 press release that an estimated $103 million over three years from the American Rescue Plan Act, enacted in March 2021, would be used “to reduce burnout and promote mental health among the health workforce,” including those working in public safety. “Health care providers face many challenges and stresses due to high patient volumes, long work hours and workplace demands.” The pandemic amplified these challenges, which “had a disproportionate impact on communities of color” and in rural areas, the release stated.

Pew’s Stateline published an article in August 2021 by Mike Ollove titled “The Pandemic Has Devastated the Mental Health of Public Health Workers.” People in that line of work “have been vilified by a portion of the public and attacked by some political leaders and media figures” or even “fired or forced from office.” They have been cursed at, endured protests against them, and more. Ollove cites a Centers for Disease Control and Prevention survey released in July 2021 that “found that more than half of people working in public health at the state, tribal, local and territorial levels during the pandemic reported symptoms of at least one serious mental health condition,” including depression, posttraumatic stress disorder, and suicidal thoughts.

Arthur Evans Jr., CEO and executive vice president of the American Psychological Association (APA), was a plenary speaker at the Grantmakers In Health (GIH) virtual Annual Conference on Health Philanthropy in June 2021. His engaging remarks on “A New Behavioral Health Paradigm” are available on YouTube. We are “facing the greatest mental health crisis” in our lifetimes, he said, because of the pandemic, economic downturn, greater effects of the COVID-19 pandemic on communities of color, racial reckoning, and a “tumultuous” 2020 election season. According to the APA’s Stress in America 2020 survey, 78 percent of Americans said that the pandemic was “a significant stressor” in their lives. Evans said that even before the pandemic, the approach to behavioral health in the US was “inadequate.” After explaining that social determinants of health have a role in mental health status, Evans said that we need to move to a “population health approach.” Whether a person is diagnosed with a mental health condition, is at risk for one, or is currently healthy, they can be helped in different ways. He gave examples from his work as commissioner of the Department of Behavioral Health and Intellectual disAbility Services, in Philadelphia, Pennsylvania. For example, the key to helping people with serious mental illness who are experiencing homelessness is to get them housing. He suggested that foundations could reach new groups by going beyond just treatment to advance whole-population health. Foundations can also take risks in funding (which risk-averse policy makers would avoid), and funders could bring credibility to this new approach. Missouri Foundation for Health funded this GIH session.

In a May 2021 press release, the Centers for Medicare and Medicaid Services reported that according to its data, Medicaid and Children’s Health Insurance Program enrollees are “forgoing mental health care” during the pandemic.

Following are some examples of how foundations all over the United States are funding efforts to improve mental health.

Recent Grants

In August 2021 St. David’s Foundation, which funds in central Texas, announced $1 million in grants for its initiative called Perinatal Safe Zone—Supporting Healthier Pregnancies Together, according to an e-alert. Twelve nonprofits, eleven of which are led by people of color, received grants. The initiative aims to ensure that “pregnant families, regardless of background, not only have access to the clinical services they need, when they need them,” but also have access to nonclinical services supporting pregnancy, such as healthy food. The initiative focuses on “local programs that are designed and led by communities most impacted by birth inequities.” According to the request for proposals, “addressing maternal mental health conditions to reduce complications of pregnancy and childbirth” was among the priorities that applicants should have considered including. Poor maternal mental health can affect “infant care, bonding, and child development” and can cause children to have “adverse childhood experiences,” the funder noted.

In July 2021 the Advancing a Healthier Wisconsin Endowment announced a $359,173 grant to the War Memorial Center, in Milwaukee, to assess the effectiveness of a sustained mass media and social media messaging campaign aimed at preventing suicide among veterans in the state. The campaign strives to “increase help-seeking behaviors” and decrease suicide risk by encouraging safe firearm storage, said Bertrand D. Berger at the Medical College of Wisconsin (MCW), who is the project’s academic partner. Collaborators include MCW, the Milwaukee VA Medical Center, and the Gun Shop Project of Wisconsin.

Perigee Fund is a national philanthropy based in Seattle, Washington, focused on prenatal-to-age-three mental health. Its 2021 funding includes a $200,000 grant to the American Academy of Pediatrics (AAP) “to develop and implement a national infant and early childhood mental health Project ECHO learning collaborative” for twenty-five pediatric practices across the US, Elizabeth Krause, Perigee’s director of programs, said in an e-mail. Project ECHO, as succinctly described in an unrelated New York State Health Foundation (NYSHealth) publication, “increases access to specialty treatment for patients in rural and underserved areas by providing frontline physicians with the knowledge and support…to manage patients with complex conditions.” The Perigee grant also supports “dissemination and piloting of AAP’s new perinatal depression curriculum” for pediatric residency programs, Krause noted.

Caring for Colorado Foundation (CCF) awarded a $48,000 grant to Children’s Hospital Colorado Foundation. The hospital’s Black Health Initiative (BHI) is working with the hospital’s Healthy Expectations Perinatal Mental Health Program on a project to serve Black women and their infants “in metro Denver with perinatal mental health care concerns” and to focus on those who have not had access to or felt comfortable with mental health services, according to CCF materials. The project will bring in a Black, culturally responsive perinatal psychiatrist to lead BHI’s mom-to-mom peer support group. If additional mental health support is necessary, mothers are able to access other programs on the University of Colorado Anschutz Medical Campus.

In February 2021 the Colorado Health Foundation made a $191,520 grant to the Don’t Look Back Center, in Aurora, for “peer-led recovery, daily living skill building, and outreach programs for women and transwomen who have faced trauma and mental health challenges,” the foundation said. Such programming offers trans women and women of color safety, health services, and more. The Substance Abuse and Mental Health Services Administration also funds this effort.

ZOMA Foundation funds perinatal mental health projects in five counties in the Denver, Colorado, area. ZOMA aims to raise “the standard of mental health screening and care from conception through twelve months postpartum” to support “a strong bond between parents and child,” its website says.

Grant Outcomes

The Leona M. and Harry B. Helmsley Charitable Trust announced in its July 2021 Rural Healthcare newsletter that “the inaugural class of Montana’s first psychiatry residency program” has arrived in Billings. Mentored by faculty, the three residents are starting to see patients at the Billings Clinic. This “regional track of the University of Washington Psychiatry Residency Training Program” launched in 2019 with $3 million in funding from Helmsley. The four-year program “will offer interesting opportunities” to work with Indian Health Service clinics, rural health centers, school districts, and the state hospital.

In July 2021 a mental health policy center focused on the Paso del Norte region launched at the Meadows Mental Health Policy Institute, in Dallas, Texas. A $1.5 million Paso del Norte Health Foundation grant established the center, which will support regional initiatives and combat “stigma of mental illness.”

The Montana Healthcare Foundation (MHCF) and the Montana Department of Public Health and Human Services cofund the Meadowlark Initiative. It “provides funding and technical assistance to allow medical practices that provide prenatal and postpartum care to implement a coordinated, team-based approach that improves outcomes for women” with mental illness and substance use disorder, according to the MHCF website. As of an October 2020 update, fifteen sites participated, and prenatal providers were “becoming more comfortable screening” patients for behavioral health conditions.

In 2020 the Physicians Foundation released Part Two: COVID-19’s Impact on Physician Wellbeing, part of its 2020 Survey of America’s Physicians. Conducted in August 2020, the survey found that “50 percent of physicians have experienced inappropriate anger, tearfulness or anxiety as a result of COVID-19’s effects on their practice or employment.” Thirty percent of doctors said that they felt hopeless or without purpose because of such effects.

Published Work

In July 2021 NYSHealth released a short report, “Still Recovering: Mental Health Impact of the COVID-19 Pandemic in New York State.” These self-reported data, collected from May 7, 2020, until May 24, 2021, come from the Census Bureau’s experimental COVID-19 Household Pulse Survey. In May 2020, 35 percent of those surveyed said that they had experienced depression or anxiety symptoms or both in the week before. That figure grew to 40 percent in February 2021 and declined to 32 percent in May 2021. Among other key findings was that in May 2021, 57 percent of “food-scarce New Yorkers” reported “poor mental health” compared with 29 percent of food-secure respondents.

Behavioral health is among the topics in which the California Health Care Foundation (CHCF) works. Its May 2021 fact sheet titled “Psychiatric Collaborative Care Management Benefit in Medi-Cal” describes “an evidence-based model” approved by California Medicaid “for integrating physical and behavioral health services in a primary care setting, while maximizing the impact of a limited behavioral health workforce.” Also, in November 2020 CHCF published a short report with data from fiscal years 2014–15 through 2017–18, titled “Mental Health Disparities by Race and Ethnicity for Adults in Medi-Cal.” A 2017 state law “requires robust tracking and evaluation measures for mental health services in Medi-Cal.” The report notes that access to services “falls short of estimated prevalence” of mental illness.

In March 2021 Mathematica published an issue brief titled “Untreated Maternal Mental Health Conditions in Texas: Costs to Society and to Medicaid.” Funded by St. David’s Foundation, the brief aims to inform a strategic plan—requested by the Texas legislature—to address postpartum depression, as well as other efforts to address maternal mental health conditions (MMHCs), including anxiety disorders, in the state. Mathematica’s model “quantifies the monetary costs of untreated MMHCs” from conception through five years postpartum. The estimated societal cost in Texas, including the cost to the state’s Medicaid program, was $2.2 billion in 2019, but that dollar amount “does not fully capture the human costs,” the researchers note.

The Bipartisan Policy Center published “Tackling America’s Mental Health and Addiction Crisis through Primary Care Integration: Task Force Recommendations” in March 2021. Well Being Trust (WBT), the Sunflower Foundation, and the New York Community Trust funded the report; one of its recommendations is to “enable greater integration” by increasing behavioral health providers’ use of electronic health records.

“COVID-19, Structural Racism, and Mental Health Inequities: Policy Implications for an Emerging Syndemic,” published in winter 2021, explains that a “syndemic” results from converging conditions. Funded by the Thomas Scattergood Behavioral Health, Peg’s, Patrick P. Lee, and Peter and Elizabeth Tower Foundations, the paper is one in a series that was edited by Howard Goldman and Constance Gartner. A subset of these papers were published in Psychiatric Services. Among the authors’ recommendations is to “expand financial supports for mental health service delivery.” The authors say that services and supports “available through traditional…service delivery in hospital and community-based settings should be realigned…to increase access through telehealth and home-based solutions.”

“Understanding Suicide Risk and Prevention” is a January 2021 Health Affairs Health Policy Brief that was funded by the Robert Wood Johnson Foundation. One important point made is that the health care, criminal justice, and education systems can collaborate to prevent suicides.

The Hogg Foundation for Mental Health published A Guide to Understanding Mental Health Systems and Services in Texas, 5th Edition, in November 2020. Chapters include “The Intersection of Racism and Mental Health” and “Telemedicine and Telehealth in the Time of COVID-19.”

Of note, the Commonwealth Fund published a June 2021 dialogue on “Building Better Systems of Care for People with Mental Health Problems.” Sarah Klein and Martha Hostetter led this roundtable discussion with Paul Gionfriddo, recently retired from Mental Health America; Emma Beth McGinty of the Johns Hopkins Bloomberg School of Public Health; Ben Miller of WBT; and Brian Smedley of the APA. Also, the California Endowment funded two July 2021 University of California Los Angeles Center for Health Policy Research briefs on mental health needs in California’s Latino and Asian communities.

Other Funders

Following are some behavioral health funders (more details are available on their websites): Headwaters Foundation (western Montana), Missouri Foundation for Health, the Aetna Foundation, the Blue Cross Blue Shield of Massachusetts Foundation, Episcopal Health Foundation (fifty-seven Texas counties), Ethel and James Flinn Foundation (Michigan), Florida Blue Foundation, Hersh Foundation (north Texas), Horizon Foundation (Howard County, Maryland), Jewish Healthcare Foundation (southwestern Pennsylvania), Meadows Foundation (Texas), and Michigan Health Endowment Fund. Others include Texoma Health Foundation (four counties in Texas), the Rhode Island Foundation, Staunton Farm Foundation (southwestern Pennsylvania), Valley Baptist Legacy Foundation (four counties in Texas), Jesse Parker Williams Foundation (Atlanta, Georgia, area), and Williamsburg Health Foundation (Williamsburg, Virginia).

Key Personnel Changes

Fatima Angeles

is the new executive director of the Levi Strauss Foundation. Its areas of focus include HIV/AIDS and worker well-being “to improve the lives of the people who make [Levi Strauss] products,” according to its website. Previously Angeles was vice president of programs at the California Wellness Foundation. She was employed there for twenty-three years.

Ben Miller

has been promoted from chief strategy officer to president of Well Being Trust, “an impact philanthropy focused on advancing the mental, social, and spiritual health of the nation,” according to a June 2021 press release. Trained as a clinical psychologist, Miller “is a nationally recognized leader in the area of mental health and health policy.” He will work alongside Tyler Norris, the trust’s CEO, explained Rod Hochman, its board chair, in the release.

Teresa Miller

became president and CEO of the Kansas Health Foundation in May 2021, according to its website. Previously, she served as secretary of the Pennsylvania Department of Human Services and before that, as Pennsylvania’s insurance commissioner. She now serves on the Congressional Budget Office’s Panel of Health Advisers.

Compiled and written by Lee L. Prina, senior editor